A 37-year-old female postextracranial-intracranial bypass, superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, and angioplasty for treatment of Moyamoya disease was treated over a 13-month period with speech therapy for spastic dysarthria. Moyamoya disease course, epidemiology, etiological theories, and the current treatment options are briefly discussed. In addition, the individual's recovery of velopharyngeal function, articulatory precision and other aspects of oral motor strength and range of motion are described in this case report. A reduction in speaking rate from baseline was successfully employed during therapy sessions. Untreated parameters such as sensorineural hearing loss and immediate memory impairment demonstrated resolution, as well, and are discussed. Spastic vocal quality did not improve. Treatment efficacy, with the exception of reduced speaking rate within sessions, could not be determined with any degree of certainty in this individual. Unique factors hypothesized to have contributed to spontaneous recovery following surgical management of Moyamoya disease are highlighted.